H\u00c0NH CH\u00cdNH:<\/b><\/p>\n
1. T\u00ean m\u00f4n h\u1ecdc: Nhi c\u01a1 s\u1edf<\/p>\n
2. T\u00ean b\u00e0i h\u1ecdc: B\u1ec6NH XU\u1ea4T HUY\u1ebeT N\u00c3O, M\u00c0NG N\u00c3O \u1ede TR\u1eba EM<\/p>\n
3. B\u00e0i gi\u1ea3ng: L\u00fd thuy\u1ebft<\/p>\n
4. \u0110\u1ed1i t\u01b0\u1ee3ng: Sinh vi\u00ean Y4 + CT3<\/p>\n
5. Th\u1eddi gian: 1 ti\u1ebft<\/p>\n
6. \u0110\u1ecba \u0111i\u1ec3m: Gi\u1ea3ng \u0111\u01b0\u01a1ng<\/p>\n
M\u1ee4C TI\u00caU<\/b><\/p>\n
1. Li\u1ec7t k\u00ea c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y xu\u1ea5t huy\u1ebft n\u00e3o, m\u00e0ng n\u00e3o (XHNMN) theo l\u1ee9a tu\u1ed5i.<\/p>\n
2. Tr\u00ecnh b\u00e0y \u0111\u01b0\u1ee3c tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng, c\u1eadn l\u00e2m s\u00e0ng XHNMN.<\/p>\n
3. Tr\u00ecnh b\u00e0y c\u00e1c nguy\u00ean t\u1eafc \u0111i\u1ec1u tr\u1ecb b\u1ec7nh.<\/p>\n
1. \u0110\u1ea0I C\u01af\u01a0NG<\/b><\/p>\n
XHNMN \u1edf tr\u1ebb em c\u00f3 th\u1ec3 do nguy\u00ean nh\u00e2n b\u1ea9m sinh ho\u1eb7c m\u1eafc ph\u1ea3i. C\u00e1c nguy\u00ean nh\u00e2n b\u1ea9m sinh th\u01b0\u1eddng do d\u1ecb d\u1ea1ng \u0111\u1ed9ng m\u1ea1ch, t\u0129nh m\u1ea1ch.<\/p>\n
C\u00e1c nguy\u00ean nh\u00e2n m\u1eafc ph\u1ea3i bao g\u1ed3m c\u00e1c bi\u1ebfn ch\u1ee9ng m\u1ea1ch m\u00e1u n\u00e3o do c\u00e1c b\u1ec7nh nhi\u1ec5m khu\u1ea9n, ch\u1ea5n th\u01b0\u01a1ng, c\u00e1c b\u1ec7nh h\u1ec7 th\u1ed1ng v\u00e0 c\u00e1c th\u1ec3 t\u1ea1ng d\u1ec5 ch\u1ea3y m\u00e1u, trong \u0111\u00f3 c\u00f3 c\u00e1c b\u1ec7nh r\u1ed1i lo\u1ea1n c\u1ea9m m\u00e1u hay g\u1eb7p \u1edf tr\u1ebb em.<\/p>\n
Nguy\u00ean nh\u00e2n thi\u1ebfu Vitamin K l\u00e0 m\u1ed9t trong nh\u1eefng nguy\u00ean nh\u00e2n\u00a0hay g\u1eb7p nh\u1ea5t<\/b>. X\u1ea3y ra t\u1eeb\u00a02 tu\u1ea7n \u0111\u1ebfn 6 th\u00e1ng sau sinh<\/b>, th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 kho\u1ea3ng th\u1eddi gian t\u1eeb 2 tu\u1ea7n \u0111\u1ebfn 2 th\u00e1ng. X\u1ea3y ra \u1edf tr\u1ebb \u0111\u1ee7 th\u00e1ng, kh\u1ecfe m\u1ea1nh, kh\u00f4ng c\u00f3 ti\u1ec1n c\u0103n b\u1ec7nh v\u1ec1 m\u00e1u, kh\u00f4ng c\u00f3 ti\u1ec1n c\u0103n sang ch\u1ea5n s\u1ea3n khoa, b\u00fa m\u1eb9 ho\u00e0n to\u00e0n v\u00e0 kh\u00f4ng ch\u00edch d\u1ef1 ph\u00f2ng vitamin K l\u00fac sanh.<\/p>\n
Xu\u1ea5t huy\u1ebft c\u00f3 th\u1ec3 x\u1ea3y ra trong nhu m\u00f4 n\u00e3o, n\u00e3o th\u1ea5t hay trong m\u1ed9t ho\u1eb7c nhi\u1ec1u m\u00e0ng bao n\u00e3o (d\u01b0\u1edbi m\u00e0ng nh\u1ec7n, m\u00e0ng c\u1ee9ng, ngo\u00e0i m\u00e0ng c\u1ee9ng) g\u00e2y n\u00ean t\u1ec9 l\u1ec7 t\u1eed vong v\u00e0 di ch\u1ee9ng v\u0129nh vi\u1ec5n cao.<\/p>\n
2. D\u1ecaCH T\u1ec4 H\u1eccC<\/b><\/p>\n
– T\u1ea7n su\u1ea5t m\u1eafc b\u1ec7nh XHNMN: T\u1ea7n su\u1ea5t m\u1eafc b\u1ec7nh cao \u1edf c\u00e1c qu\u1ed1c gia ch\u01b0a s\u1eed d\u1ee5ng vitamine K ph\u00f2ng ng\u1eeba th\u01b0\u1eddng qui cho t\u1ea5t c\u1ea3 c\u00e1c tr\u1ebb sau sinh. T\u1ec9 l\u1ec7 n\u00e0y l\u00e0 1\/4500 tr\u1ebb \u1edf Nh\u1eadt (1982), 1\/1200 \u1edf Th\u00e1i lan (1987) v\u00e0 t\u1ec9 l\u1ec7 n\u00e0y gi\u1ea3m h\u1eb3n \u1edf c\u1ea3 2 qu\u1ed1c gia tr\u00ean khi vitamine K ph\u00f2ng ng\u1eeba \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng th\u01b0\u1eddng qui cho tr\u1ebb sau sinh.<\/p>\n
– T\u1ec9 l\u1ec7 nam\/n\u1eef: Vi\u1ec7t Nam: nam\/n\u1eef: 3\/1 (BVN\u0110 1), Th\u00e1i Lan: nam\/n\u1eef: 2,7\/1, Nh\u1eadt: nam\/n\u1eef: 2\/1. \u0110i\u1ec1u n\u00e0y c\u00f3 th\u1ec3 do Androgen l\u00e0m t\u0103ng bi\u1ebfn d\u01b0\u1ee1ng vitamin K ho\u1eb7c ho\u1ea1t \u0111\u1ed9ng nh\u01b0 Wafarin \u0111\u00e3 l\u00e0m gia t\u0103ng t\u00ecnh tr\u1ea1ng thi\u1ebfu vitamin K v\u1ed1n d\u0129 \u0111\u00e3 th\u1ea5p \u1edf tr\u1ebb s\u01a1 sinh.<\/p>\n
– Ch\u1ebf \u0111\u1ed9 dinh d\u01b0\u1ee1ng: b\u1ec7nh c\u1ee7a tr\u1ebb b\u00fa m\u1eb9 ho\u00e0n to\u00e0n m\u00e0 kh\u00f4ng s\u1eed d\u1ee5ng vitamin K ph\u00f2ng ng\u1eeba l\u00fac sinh.<\/p>\n
– Th\u1eddi gian m\u1eafc b\u1ec7nh: th\u01b0\u1eddng x\u1ea3y ra t\u1eeb 2 tu\u1ea7n \u0111\u1ebfn 6 th\u00e1ng, t\u1ea7n su\u1ea5t cao nh\u1ea5t t\u1eeb 2 tu\u1ea7n \u0111\u1ebfn 2 th\u00e1ng.<\/p>\n
3. B\u1ec6NH NGUY\u00caN<\/b><\/p>\n
3.1. \u1ede tr\u1ebb s\u01a1 sinh<\/b><\/p>\n
– Ch\u1ea5n th\u01b0\u01a1ng s\u1ea3n khoa do thai qu\u00e1 to so v\u1edbi khung ch\u1eadu ng\u01b0\u1eddi m\u1eb9, ng\u00f4i thai b\u1ea5t l\u1ee3i, d\u00e2y rau qu\u1ea5n c\u1ed5 g\u00e2y \u0111\u1ebb kh\u00f3.<\/p>\n
– Th\u1eddi gian chuy\u1ec3n d\u1ea1 k\u00e9o d\u00e0i<\/p>\n
– \u0110\u1ebb qu\u00e1 nhanh, \u0111\u1ebb ph\u1ea3i can thi\u1ec7p forcep, gi\u00e1c h\u00fat\u2026<\/p>\n
– V\u1ee1 \u1ed1i s\u1edbm<\/p>\n
– Thai gi\u00e0 th\u00e1ng c\u0169ng l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1, do suy tho\u00e1i b\u00e1nh rau d\u1eabn \u0111\u1ebfn thi\u1ebfu oxy cho thai.<\/p>\n
– \u0110\u1eb7c \u0111i\u1ec3m c\u1ee7a h\u1ec7 c\u1ea7m m\u00e1u \u1edf tr\u1ebb s\u01a1 sinh ch\u01b0a ho\u00e0n ch\u1ec9nh, c\u1ea5u t\u1ea1o th\u00e0nh m\u1ea1ch c\u00f2n m\u1ecfng, \u0111\u00e1m r\u1ed1i quanh n\u00e3o th\u1ea5t \u0111\u01b0\u1ee3c t\u0103ng t\u01b0\u1edbi m\u00e1u v\u00e0 l\u00e0 t\u1ed5 ch\u1ee9c non y\u1ebfu c\u1ee7a n\u00e3o n\u00ean d\u1ec5 ch\u1ea3y m\u00e1u.<\/p>\n
– T\u1ed5n th\u01b0\u01a1ng thi\u1ebfu oxy do r\u1ed1i lo\u1ea1n tu\u1ea7n ho\u00e0n, suy h\u00f4 h\u1ea5p s\u01a1 sinh<\/p>\n
– Gi\u1ea3m t\u1ec9 l\u1ec7 prothrombin ngay ng\u00e0y \u0111\u1ea7u v\u00e0 ng\u00e0y th\u1ee9 ba \u2013 th\u1ee9 n\u0103m sau \u0111\u1ebb do thi\u1ebfu vitamin K<\/p>\n
– S\u1eed d\u1ee5ng c\u00e1c dung d\u1ecbch \u01b0u tr\u01b0\u01a1ng, dung d\u1ecbch natri bicarbonate trong h\u1ed3i s\u1ee9c s\u01a1 sinh qu\u00e1 li\u1ec1u.<\/p>\n
3.2. \u1ede tr\u1ebb c\u00f2n b\u00fa<\/b><\/p>\n
– Gi\u1ea3m t\u1ec9 l\u1ec7 prothrombin do thi\u1ebfu vitamin K, l\u00e0 y\u1ebfu t\u1ed1 c\u00e2n thi\u1ebft tham gia t\u1ea1o n\u00ean c\u00e1c y\u1ebfu t\u1ed1 \u0111\u00f4ng m\u00e1u II, VII, IX, X.<\/p>\n
– M\u1ed9t s\u1ed1 y\u1ebfu t\u1ed1 nguy c\u01a1: b\u1ec7nh th\u01b0\u1eddng x\u1ea3y ra \u1edf tr\u1ebb t\u1eeb 2 tu\u1ea7n \u0111\u1ebfn 3 th\u00e1ng, con trai hay m\u1eafc b\u1ec7nh, tr\u1ebb kh\u1ecfe m\u1ea1nh, tr\u1ebb \u0111\u01b0\u1ee3c nu\u00f4i s\u1eefa m\u1eb9, ng\u01b0\u1eddi m\u1eb9 kh\u1ecfe m\u1ea1nh, \u0103n u\u1ed1ng ki\u00eang khem.<\/p>\n
– C\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c:<\/p>\n
o Vi\u00eam gan virus<\/p>\n
o D\u1ecb d\u1ea1ng \u0111\u01b0\u1eddng m\u1eadt b\u1ea9m sinh, k\u00e9n \u1ed1ng m\u1eadt ch\u1ee7<\/p>\n
o X\u01a1 gan<\/p>\n
o H\u1ed9i ch\u1ee9ng k\u00e9m h\u1ea5p thu<\/p>\n
o X\u01a1 nang t\u1ee5y t\u1ea1ng<\/p>\n
o Kh\u00f4ng c\u00f3 betalipoprotein m\u00e1u<\/p>\n
o Ti\u00eau ch\u1ea3y k\u00e9o d\u00e0i<\/p>\n
o S\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng m\u00e1u<\/p>\n
o C\u00e1c b\u1ec7nh nhi\u1ec5m khu\u1ea9n n\u1eb7ng, s\u1eed d\u1ee5ng kh\u00e1ng sinh d\u00e0i ng\u00e0y.<\/p>\n
– M\u1ed9t s\u1ed1 nguy\u00ean nh\u00e2n r\u1ea5t hi\u1ebfm g\u1eb7p: b\u1ec7nh ch\u1ea3y m\u00e1u do gi\u1ea3m ti\u1ec3u c\u1ea7u ti\u00ean ph\u00e1t ho\u1eb7c th\u1ee9 ph\u00e1t, b\u1ec7nh \u01b0a ch\u1ea3y m\u00e1u, nhi\u1ec5m khu\u1ea9n n\u1eb7ng g\u00e2y r\u1ed1i loan c\u1ea7m m\u00e1u, d\u1ecb d\u1ea1ng m\u1ea1ch m\u00e1u n\u00e3o, ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o\u2026<\/p>\n
3.3. \u1ede tr\u1ebb l\u1edbn<\/b><\/p>\n
– D\u1ecb d\u1ea1ng m\u1ea1ch m\u00e1u, 80% tr\u01b0\u1eddng h\u1ee3p do v\u1ee1 t\u00fai ph\u00f2ng \u0111\u1ed9ng m\u1ea1ch, th\u00f4ng \u0111\u1ed9ng \u2013 t\u0129nh m\u1ea1ch.<\/p>\n
– Ch\u1ea5n th\u01b0\u01a1ng s\u1ecd n\u00e3o<\/p>\n
– B\u1ec7nh xu\u1ea5t huy\u1ebft gi\u1ea3m ti\u1ec3u c\u1ea7u, b\u1ec7nh \u01b0a ch\u1ea3y m\u00e1u, b\u1ec7nh b\u1ea1ch c\u1ea7u c\u1ea5p.<\/p>\n
– B\u1ec7nh vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n, vi\u00eam m\u00e0ng n\u00e3o, vi\u00eam n\u00e3o.<\/p>\n
– U th\u1ea7n kinh \u0111\u1ec7m di c\u0103n.<\/p>\n
– U m\u1ea1ch, \u0111\u00e1m r\u1ed1i m\u1ea1ch m\u1ea1c.<\/p>\n
– Lupus ban \u0111\u1ecf r\u1ea3i r\u00e1c, vi\u00eam quanh m\u1ea1ch n\u00fat.<\/p>\n
– X\u01a1 gan, suy th\u1eadn.<\/p>\n
– Ng\u1ed9 \u0111\u1ed9c r\u01b0\u1ee3u, amphetamine\u2026<\/p>\n
4. L\u00c2M S\u00c0NG<\/b><\/p>\n
– B\u1ec7nh th\u01b0\u1eddng kh\u1edfi ph\u00e1t \u0111\u1ed9t ng\u1ed9t, di\u1ec5n ti\u1ebfn r\u1ea5t nhanh \u0111\u1ebfn t\u00ecnh tr\u1ea1ng suy s\u1ee5p to\u00e0n th\u00e2n, t\u1eeb v\u00e0i ph\u00fat \u0111\u1ebfn v\u00e0i ng\u00e0y t\u00f9y theo m\u1ee9c \u0111\u1ed9 xu\u1ea5t huy\u1ebft n\u00e3o m\u00e0ng n\u00e3o.<\/p>\n
– Tr\u01b0\u1edbc khi c\u00f3 \u0111\u1ee3t xu\u1ea5t huy\u1ebft c\u1ea5p, tr\u1ebb th\u01b0\u1eddng c\u00f3 nh\u1eefng bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u nh\u01b0: \u1ecdc s\u1eefa nhi\u1ec1u, b\u00fa k\u00e9m ho\u1eb7c b\u1ecf b\u00fa, b\u1ee9c r\u1ee9t, kh\u00f3c th\u00e9t\u2026<\/p>\n
– D\u00f9 xu\u1ea5t huy\u1ebft \u1edf \u0111\u00e2u, tr\u00ean l\u00e2m s\u00e0ng XHNMN c\u00f3 hai h\u1ed9i ch\u1ee9ng sau:<\/p>\n
4.1.H\u1ed9i ch\u1ee9ng thi\u1ebfu m\u00e1u c\u1ea5p<\/b><\/p>\n
– Da xanh, ni\u00eam nh\u1ee3t.<\/p>\n
– M\u1ea1ch nhanh, nh\u1ecf, huy\u1ebft \u00e1p t\u1ee5t:<\/p>\n
o Tr\u1ebb 1-12 th\u00e1ng: HAmax < 70 mmHg<\/p>\n
o Tr\u1ebb t\u1eeb 1-10 tu\u1ed5i: HAmax < 70 mmHg + (2 x tu\u1ed5i)<\/p>\n
o Tr\u1ebb >10 tu\u1ed5i : HAmax < 90 mmHg<\/p>\n
– Th\u1edf nhanh, t\u00edm m\u00f4i v\u00e0 \u0111\u1ea7u chi.<\/p>\n
– Thi\u1ec3u ni\u1ec7u, v\u00f4 ni\u1ec7u:<\/p>\n
o Thi\u1ec3u ni\u1ec7u: <0,5ml\/kg\/gi\u1edd (\u1edf tr\u1ebb em <300ml\/ng\u00e0y)<\/p>\n
o V\u00f4 ni\u1ec7u: < 1ml\/kg\/ng\u00e0y.<\/p>\n
4.2.H\u1ed9i ch\u1ee9ng t\u0103ng \u00e1p l\u1ef1c n\u1ed9i s\u1ecd<\/b><\/p>\n
– Th\u1ea7n kinh<\/b><\/p>\n
+ Tri gi\u00e1c thay \u0111\u1ed5i: l\u1eeb \u0111\u1eeb, ng\u1ee7 li b\u00ec, l\u01a1 m\u01a1 ho\u1eb7c b\u1ee9c r\u1ee9c, kh\u00f3c th\u00e9t khi b\u1ed3ng b\u1ebf tr\u1ebb.<\/p>\n
+ Gi\u1ea3m ho\u1eb7c t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1.<\/p>\n
+ Co gi\u1eadt: co g\u1ed3ng khu tr\u00fa ho\u1eb7c to\u00e0n th\u00e2n.<\/p>\n
+ S\u1ee5p m\u00ed m\u1eaft, \u0111\u1ed3ng t\u1eed gi\u00e3n kh\u00f4ng \u0111\u1ec1u 2 b\u00ean, ph\u1ea3n x\u1ea1 \u00e1nh s\u00e1ng gi\u1ea3m.<\/p>\n
+ Th\u00f3p ph\u1ed3ng c\u0103ng.<\/p>\n
+ R\u1ed1i lo\u1ea1n \u0111i\u1ec1u h\u00f2a th\u00e2n nhi\u1ec7t. S\u1ed1t cao c\u00f3 th\u1ec3 g\u1eb7p trong tr\u01b0\u1eddng h\u1ee3p t\u1ed5n th\u01b0\u01a1ng n\u00e3o n\u1eb7ng do xu\u1ea5t huy\u1ebft.<\/p>\n
Tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng:<\/p>\n
+ H\u00f4n m\u00ea<\/p>\n
+ B\u1ec7nh nhi c\u00f3 t\u01b0 th\u1ebf m\u1ea5t n\u00e3o: co c\u1ee9ng li\u00ean t\u1ee5c, g\u1ed3ng c\u01a1, b\u00e0n tay n\u1eafm ch\u1eb7t xoay trong, c\u1eb3ng tay du\u1ed7i, g\u1ed3ng v\u00e0 du\u1ed7i to\u00e0n th\u00e2n.<\/p>\n
+ \u0110\u1ed3ng t\u1eed gi\u00e3n kh\u00f4ng c\u00f2n ph\u1ea3n x\u1ea1<\/p>\n
+ Li\u1ec7t m\u1ec1m 4 chi.<\/p>\n
– H\u00f4 h\u1ea5p<\/b><\/p>\n
+ R\u1ed1i lo\u1ea1n nh\u1ecbp th\u1edf, r\u00ean r\u1ec9 t\u00edm t\u00e1i t\u1eebng c\u01a1n.<\/p>\n
+ C\u01a1n ng\u1eebng th\u1edf > 15 gi\u00e2y (th\u1edf kh\u00f4ng \u0111\u1ec1u)<\/p>\n
– Tim m\u1ea1ch<\/b><\/p>\n
+ R\u1ed1i lo\u1ea1n nh\u1ecbp tim.<\/p>\n
+ HA h\u1ea1, k\u1eb9p.<\/p>\n
5. C\u1eacN L\u00c2M S\u00c0NG<\/b><\/p>\n
5.1. Huy\u1ebft h\u1ecdc<\/b><\/p>\n
– Hct gi\u1ea3m, HC gi\u1ea3m.<\/p>\n
– Th\u1eddi gian prothrombine (TQ) k\u00e9o d\u00e0i<\/p>\n
– Test thromboplastine (TCK) k\u00e9o d\u00e0i<\/p>\n
– T\u1ec9 l\u1ec7 Prothrombin gi\u1ea3m.<\/p>\n
5.2. Sinh h\u00f3a<\/b><\/p>\n
– Toan chuy\u1ec3n h\u00f3a, PO2 gi\u1ea3m, PCO2 t\u0103ng<\/p>\n
– \u0110\u01b0\u1eddng m\u00e1u gi\u1ea3m.<\/p>\n
– Bilirubine gi\u00e1n ti\u1ebfp\/ m\u00e1u t\u0103ng \u0111\u01b0a \u0111\u1ebfn v\u00e0ng da.<\/p>\n
5.3. Ch\u1ecdc d\u00f2 d\u1ecbch n\u00e3o t\u1ee7y<\/b><\/p>\n
Tr\u01b0\u1edbc \u0111\u00e2y ch\u1ecdc d\u00f2 d\u1ecbch n\u00e3o t\u1ee7y l\u00e0 x\u00e9t nghi\u1ec7m th\u01b0\u1eddng quy \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n XHNMN. Ch\u1ecdc d\u00f2 d\u1ecbch n\u00e3o t\u1ee7y ch\u1ec9 c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n xu\u1ea5t huy\u1ebft nhi\u1ec1u d\u01b0\u1edbi m\u00e0ng nh\u1ec7n v\u00e0 lo\u1ea1i tr\u1eeb ch\u1ea9n \u0111o\u00e1n vi\u00eam m\u00e0ng n\u00e3o m\u0169. Ng\u00e0y nay, x\u00e9t nghi\u1ec7m n\u00e0y \u0111\u01b0\u1ee3c h\u1ea1n ch\u1ebf \u0111\u1ebfn m\u1ee9c t\u1ed1i \u0111a v\u00e0 d\u1ea7n \u0111\u01b0\u1ee3c thay th\u1ebf b\u1eb1ng c\u00e1c x\u00e9t nghi\u1ec7m \u00edt x\u00e2m l\u1ea5n h\u01a1n.<\/p>\n
5.4.Ch\u1ee5p n\u00e3o c\u1eaft l\u1edbp \u0111i\u1ec7n to\u00e1n (CT brain scanning)<\/b><\/p>\n
Ch\u1ea9n \u0111o\u00e1n r\u1ea5t ch\u00ednh x\u00e1c XHNMN. Ngay c\u1ea3 khi tr\u00ean l\u00e2m s\u00e0ng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng. CT c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 l\u01b0\u1ee3ng xu\u1ea5t huy\u1ebft, v\u1ecb tr\u00ed, n\u00e3o th\u1ea5t c\u00f3 b\u1ecb gi\u00e3n hay kh\u00f4ng.<\/p>\n
5.5. Si\u00eau \u00e2m xuy\u00ean th\u00f3p (Transfontanel Ultrasonography – US)<\/b><\/p>\n
– Ph\u01b0\u01a1ng ph\u00e1p n\u00e0y \u0111\u01b0\u1ee3c xem l\u00e0 v\u00f4 h\u1ea1i \u0111\u1ed1i v\u1edbi tr\u1ebb s\u01a1 sinh, kh\u00f4ng c\u1ea7n d\u00f9ng thu\u1ed1c an th\u1ea7n hay g\u00e2y m\u00ea, th\u1ef1c hi\u1ec7n \u0111\u01b0\u1ee3c nhi\u1ec1u n\u01a1i k\u1ec3 c\u1ea3 ngay gi\u01b0\u1eddng b\u1ec7nh v\u00e0 c\u0169ng kh\u00f4ng ti\u1ebfp x\u00fac v\u1edbi tia x\u1ea1 nhi\u1ec1u nh\u01b0 trong CT.<\/p>\n
– Trong XHNMN s\u01a1 sinh, si\u00eau \u00e2m v\u1eeba c\u00f3 gi\u00e1 tr\u1ecb trong ch\u1ea9n \u0111o\u00e1n, v\u1eeba c\u00f3 gi\u00e1 tr\u1ecb trong ti\u00ean l\u01b0\u1ee3ng t\u1eed vong v\u00e0 di ch\u1ee9ng. Tuy nhi\u00ean si\u00eau \u00e2m v\u1eabn c\u00f3 th\u1ec3 kh\u00f4ng ph\u00e1t hi\u1ec7n \u0111\u01b0\u1ee3c v\u1ecb tr\u00ed XHNMN khi c\u00f3 xu\u1ea5t huy\u1ebft trong nhu m\u00f4 n\u00e3o.<\/p>\n
Ph\u00e2n \u0111\u1ed9 XHNMN d\u1ef1a tr\u00ean si\u00eau \u00e2m<\/b><\/p>\n
(Lu-Ann Papile 1978)<\/p>\n
XHNMN nh\u1eb9:<\/b><\/p>\n
– \u0110\u1ed9 I: Ch\u1ec9 xu\u1ea5t huy\u1ebft \u1edf v\u00f9ng m\u00f4 \u0111\u1ec7m sinh s\u1ea3n<\/p>\n
– \u0110\u1ed9 II: Xu\u1ea5t huy\u1ebft trong n\u00e3o th\u1ea5t, kh\u00f4ng gi\u00e3n n\u00e3o th\u1ea5t<\/p>\n
XHNMN trung b\u00ecnh :<\/b><\/p>\n
– \u0110\u1ed9 III: Xu\u1ea5t huy\u1ebft trong n\u00e3o th\u1ea5t, c\u00f3 gi\u00e3n n\u00e3o th\u1ea5t<\/p>\n
XHNMN n\u1eb7ng:<\/b><\/p>\n
– \u0110\u1ed9 IV: Xu\u1ea5t huy\u1ebft trong n\u00e3o th\u1ea5t v\u00e0 nhu m\u00f4 n\u00e3o<\/p>\n
Hi\u1ec7n nay US v\u00e0 CT l\u00e0 2 ph\u01b0\u01a1ng ti\u1ec7n \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u00f4ng r\u00e3i \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh XHNMN.<\/p>\n
6. CH\u1ea8N \u0110O\u00c1N:\u00a0<\/b>Ti\u1ec1n c\u0103n m\u1eb9 – con + l\u00e2m s\u00e0ng + c\u1eadn l\u00e2m s\u00e0ng<\/p>\n
\u0110\u1eb6C T\u00cdNH<\/b><\/p>\n
XHNMN<\/b><\/p>\n
Nh\u1eb9 ho\u1eb7c trung b\u00ecnh<\/b><\/p>\n
XHNMN<\/b><\/p>\n
N\u1eb7ng<\/b><\/p>\n
1<\/p>\n
Tu\u1ed5i<\/p>\n
2 tu\u1ea7n- 2 th\u00e1ng<\/p>\n
2<\/p>\n
B\u00fa s\u1eefa m\u1eb9<\/p>\n
+++<\/p>\n
3<\/p>\n
D\u1ef1 ph\u00f2ng<\/p>\n
Vitamine K l\u00fac sinh<\/p>\n
Kh\u00f4ng<\/p>\n
4<\/p>\n
Tri\u1ec7u ch\u1ee9ng kh\u1edfi ph\u00e1t<\/p>\n
B\u00fa k\u00e9m hay b\u1ecf b\u00fa<\/p>\n
B\u1ee9t r\u1ee9t , kh\u00f3c th\u00e9t<\/p>\n
5<\/p>\n
Tri gi\u00e1c<\/p>\n
– T\u1ec9nh , l\u1eeb \u0111\u1eeb , ng\u1ee7 l\u1ecbm<\/p>\n
– Kh\u00f4ng co gi\u1eadt ho\u1eb7c co gi\u1eadt nh\u1eb9<\/p>\n
– Di\u1ec5n ti\u1ebfn \u0111\u1ed9t ng\u1ed9t v\u00e0o h\u00f4n m\u00ea nhanh.<\/p>\n
– Co gi\u1eadt li\u00ean t\u1ee5c ki\u1ec3u m\u1ea5t n\u00e3o.<\/p>\n
– D\u1ea5u hi\u1ec7u TK: \u0111\u1ed3ng t\u1eed gi\u00e3n kh\u00f4ng \u0111\u1ec1u, PXAS gi\u1ea3m ho\u1eb7c m\u1ea5t<\/p>\n
6<\/p>\n
H\u00f4 h\u1ea5p<\/p>\n
Kh\u00f4ng suy h\u00f4 h\u1ea5p<\/p>\n
C\u00f3 SHH ( c\u01a1n ng\u01b0ng th\u1edf)<\/p>\n
7<\/p>\n
Th\u00f3p<\/p>\n
Kh\u00f4ng ph\u1ed3ng ho\u1eb7c ph\u1ed3ng nh\u1eb9, v\u1eeba.<\/p>\n
C\u0103ng ph\u1ed3ng<\/p>\n
8<\/p>\n
Thi\u1ebfu m\u00e1u<\/p>\n
Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng k\u00edn \u0111\u00e1o<\/p>\n
Xanh t\u00e1i , gan to<\/p>\n
9<\/p>\n
Si\u00eau \u00e2m<\/p>\n
XHNMN \u0111\u1ed9 I,II, II<\/p>\n
XHNMN \u0111\u1ed9 IV<\/p>\n
10<\/p>\n
CLS<\/p>\n
Gi\u1ea3m ph\u1ee9c h\u1ee3p Prothrombin<\/p>\n
PT,PTT k\u00e9o d\u00e0i ,TT b\u00ecnh th\u01b0\u1eddng<\/p>\n
11<\/p>\n
\u0110i\u1ec1u tr\u1ecb<\/p>\n
\u0110\u00e1p \u1ee9ng<\/p>\n
7. \u0110I\u1ec0U TR\u1eca<\/b><\/p>\n
Ch\u1ea9n \u0111o\u00e1n s\u1edbm v\u00e0 \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi XHMNM l\u00e0 m\u1ed9t v\u1ea5n \u0111\u1ec1 t\u1ed1i quan tr\u1ecdng, b\u1edfi v\u00ec b\u1ea5t k\u1ef3 m\u1ed9t s\u1ef1 ch\u1eadm tr\u1ec5 n\u00e0o c\u0169ng c\u00f3 th\u1ec3 \u0111\u01b0a \u0111\u1ebfn t\u1eed vong v\u00e0 di ch\u1ee9ng n\u1eb7ng n\u1ec1<\/p>\n
Nguy\u00ean t\u1eafc chung:<\/p>\n
– \u0110i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u.<\/p>\n
– \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3.<\/p>\n
– L\u00e0m ch\u1ed7 ch\u1ea3y m\u00e1u kh\u00f4ng lan r\u1ed9ng v\u00e0 th\u00e0nh l\u1eadp sang th\u01b0\u01a1ng m\u1edbi<\/p>\n
7.1. \u0110i\u1ec1u tr\u1ecb \u0111\u1eb7c hi\u1ec7u:\u00a0<\/b>T\u00f9y v\u00e0o nguy\u00ean nh\u00e2n<\/p>\n
– Do thi\u1ebfu vitamin K: Vitamin K 5 mg li\u1ec1u duy nh\u1ea5t cho m\u1ecdi c\u00e2n n\u1eb7ng TM hay TB.<\/p>\n
– D\u1ecb d\u1ea1ng m\u1ea1ch m\u00e1u \u1edf tr\u1ebb l\u1edbn: Can thi\u1ec7p tr\u1ef1c ti\u1ebfp d\u1ecb d\u1ea1ng v\u00e0 lo\u1ea1i b\u1ecf b\u1eb1ng \u0111\u1eb7t k\u1eb9p th\u1eaft c\u1ed5 t\u00fai ph\u1ed3ng. \u0110\u1ed1i v\u1edbi c\u00e1c d\u1ecb d\u1ea1ng th\u00f4ng \u0111\u1ed9ng \u2013 tinh m\u1ea1ch, c\u00e1c d\u1ecb d\u1ea1ng \u1edf v\u1ecf n\u00e3o c\u00f3 th\u1ec3 c\u1eaft b\u1ecf ho\u00e0n to\u00e0n. C\u00e1c d\u1ecb d\u1ea1ng \u1edf trong s\u00e2u d\u00f9ng ph\u01b0\u01a1ng ph\u00e1p g\u00e2y t\u1eafc m\u1ed9t s\u1ed1 m\u1ea1ch nu\u00f4i. Th\u1eaft \u0111\u1ed9ng m\u1ea1ch \u00edt c\u00f3 hi\u1ec7u qu\u1ea3<\/p>\n
7.2. \u0110i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3<\/b><\/p>\n
7.2.1. Ch\u1ed1ng thi\u1ebfu m\u00e1u:<\/i><\/b><\/p>\n
Truy\u1ec1n m\u00e1u:<\/p>\n
+ Cho t\u1ea5t c\u1ea3 tr\u1ebb c\u00f3 Hct < 30%<\/p>\n
+ Ch\u1ecdn m\u00e1u t\u01b0\u01a1i to\u00e0n ph\u1ea7n<\/p>\n
+ L\u01b0\u1ee3ng 10 \u2013 20 ml\/kg,<\/p>\n
+ Ki\u1ec3m tra Hct sau truy\u1ec1n m\u00e1u.<\/p>\n
L\u01b0\u1ee3ng m\u00e1u truy\u1ec1n t\u00ednh theo c\u00f4ng th\u1ee9c:<\/p>\n
V = c\u00e2n n\u1eb7ng (kg) x 80 x (Hct mu\u1ed1n \u0111\u1ea1t \u2013 Hct \u0111o \u0111\u01b0\u1ee3c)\/Hct chai m\u00e1u<\/p>\n
N\u1ebfu kh\u00f4ng thi\u1ebfu m\u00e1u: truy\u1ec1n huy\u1ebft t\u01b0\u01a1ng t\u01b0\u01a1i.<\/p>\n
Kh\u1ea3o s\u00e1t t\u00ecnh tr\u1ea1ng \u0111\u00f4ng m\u00e1u, n\u1ebfu c\u1ea7n thi\u1ebft truy\u1ec1n \u0111\u00fang y\u1ebfu t\u1ed1 khi\u1ebfm khuy\u1ebft.<\/p>\n
7.2.2.\u00a0Ch\u1ed1ng ph\u00f9 n\u00e3o:<\/i><\/b><\/p>\n
– Th\u00f4ng kh\u00ed t\u1ed1t, h\u00fat \u0111\u00e0m nh\u1edbt, \u0111\u1eb7t NKQ gi\u00fap th\u1edf s\u1edbm b\u1eb1ng oxy.<\/p>\n
– N\u1eb1m \u0111\u1ea7u cao 300.<\/p>\n
– Gi\u1ea3m l\u01b0\u1ee3ng n\u01b0\u1edbc nh\u1eadp trong 2 ng\u00e0y \u0111\u1ea7u, l\u01b0\u1ee3ng n\u01b0\u1edbc nh\u1eadp ch\u1ec9 c\u1ea7n \u0111\u1ea1t \u0111\u1ebfn 50 – 75% nhu c\u1ea7u. \u0110\u1ebfn ng\u00e0y th\u1ee9 3, l\u01b0\u1ee3ng n\u01b0\u1edbc tr\u1edf v\u1ec1 b\u00ecnh th\u01b0\u1eddng.<\/p>\n
– Thu\u1ed1c ch\u1ed1ng ph\u00f9 n\u00e3o: l\u1ee3i ti\u1ec3u, manitol\u2026<\/p>\n
o Mannitol 20% li\u1ec1u 0,5g\/kg, 40-60 gi\u1ecdt\/ph\u00fat<\/p>\n
o Truy\u1ec1n b\u00f9 d\u1ecbch mu\u1ed1i sau khi truy\u1ec1n Mannitol.<\/p>\n
7.2.3. Ch\u1ed1ng co gi\u1eadt:<\/i><\/b><\/p>\n
– Ch\u1ed1ng co gi\u1eadt b\u1eb1ng Phenobarbital: 15-20 mg\/kg truy\u1ec1n TM trong 30 ph\u00fat, sau \u0111\u00f3 duy tr\u00ec 5 mg\/kg\/ng\u00e0y d\u00f9ng 1 l\u1ea7n.<\/p>\n
– Th\u1eddi gian \u0111i\u1ec1u tr\u1ecb t\u1ed1i \u0111a 1 tu\u1ea7n. N\u1ebfu ch\u01b0a kh\u1ed1ng ch\u1ebf \u0111\u01b0\u1ee3c co gi\u1eadt,<\/p>\n
c\u1ea7n ph\u1ea3i h\u1ed9i ch\u1ea9n b\u00e1c s\u0129 n\u1ed9i th\u1ea7n kinh.<\/p>\n
7.2.4. \u0110i\u1ec1u tr\u1ecb kh\u00e1c:<\/i><\/b><\/p>\n
– H\u1ea1n ch\u1ebf xoay tr\u1edf trong 2 ng\u00e0y \u0111\u1ea7u.<\/p>\n
– V\u1eadt l\u00fd\u200e tr\u1ecb li\u1ec7u: ngay t\u1eeb ng\u00e0y th\u1ee9 3 ho\u1eb7c khi tr\u1ebb \u0111\u00e3 \u1ed5n \u0111\u1ecbnh.<\/p>\n
– Vitamin E: li\u1ec1u 25 \u2013 50 \u0111v\/ng\u00e0y, trong 2 tu\u1ea7n. Vitamin E c\u00f3 t\u00e1c<\/p>\n
d\u1ee5ng d\u1ecdn s\u1ea1ch c\u00e1c g\u1ed1c t\u1ef1 do trong giai \u0111o\u1ea1n s\u1edbm c\u1ee7a t\u1ed5n th\u01b0\u01a1ng nhu m\u00f4 n\u00e3o l\u00e0m cho v\u1ebft th\u01b0\u01a1ng kh\u00f4ng lan r\u1ed9ng.<\/p>\n
– \u0110i\u1ec1u ch\u1ec9nh c\u00e1c r\u1ed1i lo\u1ea1n \u0111i k\u00e8m: toan ki\u1ec1m, \u0111\u01b0\u1eddng huy\u1ebft, \u0111i\u1ec7n gi\u1ea3i\u2026<\/p>\n
– Dinh d\u01b0\u1ee1ng: s\u1eefa m\u1eb9.<\/p>\n
– Kh\u00e1ng sinh \u0111i\u1ec1u tr\u1ecb nhi\u1ec5m tr\u00f9ng \u0111i k\u00e8m<\/p>\n
– Theo d\u00f5i v\u00e0 ch\u0103m s\u00f3c dinh d\u01b0\u1ee1ng:<\/p>\n
+ V\u00f2ng \u0111\u1ea7u m\u1ed7i ng\u00e0y<\/p>\n
+ S\u1ef1 ph\u00e1t tri\u1ec3n t\u00e2m th\u1ea7n v\u1eadn \u0111\u1ed9ng c\u1ee7a tr\u1ebb sau xu\u1ea5t vi\u1ec7n: m\u1ed7i 3<\/p>\n
th\u00e1ng trong n\u0103m \u0111\u1ea7u, m\u1ed7i 6 th\u00e1ng trong n\u0103m th\u1ee9 2 nh\u1eb1m theo d\u00f5i di ch\u1ee9ng v\u00e0 bi\u1ebfn ch\u1ee9ng mu\u1ed9n.<\/p>\n
8. DI CH\u1ee8NG V\u00c0 BI\u1ebeN CH\u1ee8NG<\/b><\/p>\n
V\u1edbi CT Scanning, ng\u01b0\u1eddi ta \u0111\u00e3 quan s\u00e1t \u0111\u01b0\u1ee3c XHNMN \u1edf v\u00f9ng m\u00f4 \u0111\u1ec7m sinh s\u1ea3n x\u1ea3y ra kh\u00e1 th\u01b0\u1eddng xuy\u00ean \u1edf tr\u1ebb nh\u1eb9 k\u00fd, tr\u1ebb \u0111\u1ee7 th\u00e1ng n\u01a1i xu\u1ea5t huy\u1ebft th\u01b0\u1eddng \u1edf m\u00e0ng nh\u1ec7n.<\/p>\n
8.1.Bi\u1ebfn ch\u1ee9ng<\/b><\/p>\n
– Nh\u0169n n\u00e3o ch\u1ea5t tr\u1eafng quanh n\u00e3o th\u1ea5t<\/p>\n
– Nang n\u00e3o<\/p>\n
8.2.Di ch\u1ee9ng<\/b><\/p>\n
8.2.1. Di ch\u1ee9ng s\u1edbm<\/i><\/b><\/p>\n
– Trong tu\u1ea7n l\u1ec5 \u0111\u1ea7u ti\u00ean, nguy c\u01a1 gi\u00e3n n\u00e3o th\u1ea5t r\u1ea5t cao sau XHNMN, do \u0111\u00f3 c\u1ea7n ki\u1ec3m tra theo d\u00f5i s\u00e1t \u0111\u1ec3 x\u1eed tr\u00ed ngay.<\/p>\n
– Tr\u1ebb c\u0169ng c\u00f3 nhi\u1ec1u kh\u1ea3 n\u0103ng b\u1ecb n\u00e3o \u00fang th\u1ee7y sau XHNMN do 2 c\u01a1 ch\u1ebf:<\/p>\n
+ Ngh\u1ebdn n\u00e3o th\u1ea5t \u1edf l\u1ed5 Monro do t\u1ee5 m\u00e1u.<\/p>\n
+ Vi\u00eam m\u00e0ng nu\u00f4i g\u00e2y c\u1ea3n tr\u1edf s\u1ef1 h\u1ea5p thu d\u1ecbch n\u00e3o t\u1ee7y.<\/p>\n
8.2.2. Di ch\u1ee9ng mu\u1ed9n<\/i><\/b><\/p>\n
Tr\u1ebb h\u00f4n m\u00ea > 24 gi\u1edd khi b\u1ecb XHNMN th\u01b0\u1eddng b\u1ecb di ch\u1ee9ng th\u1ea7n kinh v\u0129nh vi\u1ec5n:<\/p>\n
– R\u1ed1i lo\u1ea1n v\u1eadn \u0111\u1ed9ng: gi\u1ea3m tr\u01b0\u01a1ng l\u1ef1c c\u01a1, co c\u1ee9ng c\u01a1, li\u1ec7t c\u1ee9ng t\u1ee9 chi, co gi\u1eadt.<\/p>\n
– R\u1ed1i lo\u1ea1n c\u1ea3m gi\u00e1c: \u0111i\u1ebfc, m\u00f9.<\/p>\n
– Tr\u00ed th\u00f4ng minh gi\u1ea3m.<\/p>\n
9. PH\u00d2NG B\u1ec6NH<\/b><\/p>\n
* C\u1ea5p 0:<\/b><\/p>\n
– Khi m\u1eb9 mang thai: ph\u1ea3i kh\u00e1m thai \u0111\u1ecbnh k\u1ef3 gi\u00fap m\u1eb9 v\u00e0 thai ph\u00e1t tri\u1ec3n t\u1ed1t (\u0111\u1ee7 c\u00e2n, \u0111\u1ee7 th\u00e1ng sanh).<\/p>\n
– Nu\u00f4i con b\u1eb1ng s\u1eefa m\u1eb9, m\u1eb9 kh\u00f4ng \u0103n ki\u00eang, tuy\u00ean truy\u1ec1n gi\u00e1o d\u1ee5c ki\u1ebfn th\u1ee9c cho m\u1eb9, k\u00eau g\u1ecdi c\u00e1c ban ng\u00e0nh h\u1ee3p t\u00e1c b\u1eb1ng th\u00f4ng tin gi\u00e1o d\u1ee5c y t\u1ebf \u2026<\/p>\n
* C\u1ea5p 1<\/b>: Tr\u00e1nh sanh ng\u1ea1t \u2192 thi\u1ebfu O2, toan chuy\u1ec3n h\u00f3a, tr\u00e1nh sang ch\u1ea5n s\u1ea3n khoa, ch\u1ec9 \u0111\u1ecbnh th\u1ee7 thu\u1eadt, can thi\u1ec7p \u0111\u00fang v\u00e0 c\u1ea9n th\u1eadn.<\/p>\n
– Ph\u00f2ng cho m\u1eb9 v\u00e0 con: u\u1ed1ng ho\u1eb7c ch\u00edch vitamin K.<\/p>\n
– H\u01b0\u1edbng d\u1eabn cho b\u00e0 m\u1eb9 c\u00e1ch dinh d\u01b0\u1ee1ng kh\u00f4ng \u0103n ki\u00eang nh\u1ea5t l\u00e0 ki\u00eang d\u1ea7u m\u1ee1, n\u00ean \u0103n nhi\u1ec1u th\u1ee9c \u0103n gi\u00e0u n\u0103ng l\u01b0\u1ee3ng, vitamin nh\u01b0 rau xanh, \u0111\u1eadu, tr\u1ee9ng, c\u00e1…<\/p>\n
– Li\u1ec1u ph\u00f2ng cho tr\u1ebb m\u1edbi \u0111\u1ebb 1 li\u1ec1u vitamin K1: u\u1ed1ng 2 mg ho\u1eb7c 1 mg ti\u00eam b\u1eafp b\u1eb1ng c\u00e1ch cho t\u1ea5t c\u1ea3 tr\u1ebb m\u1edbi \u0111\u1ebb 1 li\u1ec1u vitamin K s\u1ebd h\u1ea1n ch\u1ebf \u0111\u01b0\u1ee3c ch\u1ea3y m\u00e1u n\u1eb7ng trong v\u00f2ng 6 gi\u1edd \u0111\u1ea7u sau khi sanh, g\u00f3p ph\u1ea7n gi\u1ea3m t\u1eed vong v\u00e0 h\u1ea1n ch\u1ebf t\u00e0n t\u1eadt cho tr\u1ebb em.<\/p>\n
– Vitamin K1 u\u1ed1ng 2 mg hi\u1ec7u qu\u1ea3 gi\u1ed1ng li\u1ec1u ti\u00eam b\u1eafp 1mg trong vi\u1ec7c ng\u0103n ng\u1eeba XHNMN c\u1ed5 \u0111i\u1ec3n v\u00e0 XHNMN mu\u1ed9n.<\/p>\n
– C\u1ea7n ph\u1ea3i c\u00f3 ch\u00ednh s\u00e1ch b\u1eaft bu\u1ed9c s\u1eed d\u1ee5ng vitamin K1 ph\u00f2ng ng\u1eeba cho t\u1ea5t c\u1ea3 tr\u1ebb m\u1edbi sinh. T\u1ea7m quan tr\u1ecdng qu\u1ed1c gia chi\u1ebfn l\u01b0\u1ee3c ph\u00f2ng ng\u1eeba vitamine K.<\/p>\n
Li\u1ec1u vitamin K1 s\u1ebd \u0111\u01b0\u1ee3c nh\u1eafc l\u1ea1i khi tr\u1ebb m\u1eafc nh\u1eefng b\u1ec7nh sau:<\/p>\n
– Ti\u00eau ch\u1ea3y m\u00e3n.<\/p>\n
– S\u1eed d\u1ee5ng kh\u00e1ng sinh k\u00e9o d\u00e0i.<\/p>\n
– K\u00e9m h\u1ea5p thu.<\/p>\n
– Ngh\u1ebdn t\u1eafc \u0111\u01b0\u1eddng m\u1eadt.<\/p>\n
– Ph\u1eabu thu\u1eadt ru\u1ed9t.<\/p>\n
– B\u1ec7nh Coeliac.<\/p>\n
– K\u00e9m dinh d\u01b0\u1ee1ng hay tr\u1ebb kh\u00f4ng d\u00f9ng th\u1ee9c \u0103n b\u1ed5 sung theo tu\u1ed5i.<\/p>\n
* C\u1ea5p II<\/b>: Khi tr\u1ebb b\u1ecb XHNMN ph\u1ea3i ph\u00e1t hi\u1ec7n s\u1edbm v\u00e0 kh\u1ea9n tru\u01a1ng \u0111i\u1ec1u tr\u1ecb k\u1ecbp th\u1eddi theo ph\u00e1c \u0111\u1ed3.<\/p>\n
* C\u1ea5p III<\/b>: \u0110i\u1ec1u tr\u1ecb di ch\u1ee9ng v\u00e0 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng, v\u1eadt l\u00fd tr\u1ecb li\u1ec7u cho tr\u1ebb.<\/p>\n
T\u00e1i kh\u00e1m \u0111\u1ecbnh k\u1ef3 3, 6, 9, 12 th\u00e1ng trong n\u0103m \u0111\u1ea7u ti\u00ean, sau \u0111\u00f3 gi\u1ea3m d\u1ea7n trong c\u00e1c n\u0103m ti\u1ebfp theo, Theo d\u00f5i di ch\u1ee9ng b\u1ea1i n\u00e3o \u0111i\u1ec1u tr\u1ecb s\u1edbm c\u00e0ng t\u1ed1t tr\u00e1nh nguy c\u01a1 di ch\u1ee9ng mu\u1ed9n theo d\u00f5i s\u1ef1 ph\u00e1t tri\u1ec3n t\u00e2m th\u1ea7n v\u1eadn \u0111\u1ed9ng c\u1ee7a tr\u1ebb theo bi\u1ec3u \u0111\u1ed3, VLTL \u0111\u01b0\u1ee3c h\u1ee3p t\u00e1c v\u1edbi gia \u0111\u00ecnh v\u00e0 nh\u00e2n vi\u00ean y t\u1ebf ph\u1ed1i h\u1ee3p ch\u1eb7t ch\u1ebd.<\/p>\n
T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/b><\/p>\n
1. B\u00e0i gi\u1ea3ng Nhi Khoa t\u1eadp 1, B\u1ed9 m\u00f4n Nhi tr\u01b0\u1eddng \u0110\u1ea1i H\u1ecdc Y H\u00e0 N\u1ed9i, Nh\u00e0 xu\u1ea5t b\u1ea3n Y H\u1ecdc, n\u0103m 2013.<\/p>\n
2. B\u00e0i gi\u1ea3ng Nhi Khoa t\u1eadp 1, B\u1ed9 m\u00f4n Nhi tr\u01b0\u1eddng \u0110\u1ea1i H\u1ecdc Y Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh, Nh\u00e0 xu\u1ea5t b\u1ea3n Y H\u1ecdc chi nh\u00e1nh TP HCM, n\u0103m 2013.<\/p>\n
3. C\u1ea5p c\u1ee9u h\u1ed3i s\u1ee9c nhi & s\u01a1 sinh sau \u0111\u1ea1i h\u1ecdc, B\u1ed9 m\u00f4n Nhi tr\u01b0\u1eddng \u0110\u1ea1i H\u1ecdc Y Th\u00e0nh ph\u1ed1 H\u1ed3 Ch\u00ed Minh n\u0103m 2002.<\/p>\n
4. Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb Nhi khoa, B\u1ec7nh vi\u1ec7n Nhi \u0110\u1ed3ng I, Nh\u00e0 xu\u1ea5t b\u1ea3n Y hoc n\u0103m 2013.<\/p>\n
5. Handbook IMCI: Integrated Management of Childhood Illness, WHO\/FCH\/CAH\/00, n\u0103m 2000.<\/p>\n
6. K\u1ebf ho\u1ea1ch b\u00e0i gi\u1ea3ng b\u1ed9 m\u00f4n Nhi. D\u1ef1 \u00e1n Vi\u1ec7t Nam \u2013 H\u00e0 Lan 1999.<\/p>\n
7. Janet S. Soul (2008), \u201cIntracranial hemorrhage and periventricular leukomalacia\u201d, Manual of Neonatal care, 6th edition, Lippincott Williams and Wilkins, p 499 \u2013 518.<\/p>\n","protected":false},"excerpt":{"rendered":"
H\u00c0NH CH\u00cdNH: 1. T\u00ean m\u00f4n h\u1ecdc: Nhi c\u01a1 s\u1edf 2. T\u00ean b\u00e0i h\u1ecdc: B\u1ec6NH XU\u1ea4T HUY\u1ebeT N\u00c3O, M\u00c0NG N\u00c3O \u1ede TR\u1eba EM 3. B\u00e0i gi\u1ea3ng: L\u00fd thuy\u1ebft 4. \u0110\u1ed1i t\u01b0\u1ee3ng: Sinh vi\u00ean Y4 + CT3 5. Th\u1eddi gian: 1 ti\u1ebft 6. \u0110\u1ecba \u0111i\u1ec3m: Gi\u1ea3ng \u0111\u01b0\u01a1ng M\u1ee4C TI\u00caU 1. Li\u1ec7t k\u00ea c\u00e1c nguy\u00ean nh\u00e2n g\u00e2y xu\u1ea5t …<\/p>\n","protected":false},"author":15,"featured_media":1014,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[68,69],"tags":[],"class_list":["post-1710","post","type-post","status-publish","format-standard","has-post-thumbnail","","category-nhi-khoa","category-nhi-1"],"_links":{"self":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1710","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/comments?post=1710"}],"version-history":[{"count":1,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1710\/revisions"}],"predecessor-version":[{"id":1711,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/posts\/1710\/revisions\/1711"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media\/1014"}],"wp:attachment":[{"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/media?parent=1710"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/categories?post=1710"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ykhoataynguyen.com\/site\/wp-json\/wp\/v2\/tags?post=1710"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}